Pharmacy issues

Discussion in 'Anesthesiology' started by BobLoblaw78, May 9, 2018.

  1. BobLoblaw78

    BobLoblaw78 ASA Member

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    Is anyone else running into issues with their pharmacy with most recent JC surveys such as the following:

    "Anesthesia completes wastage and associated documentation at the end of each case and or within 1 hour of drug access; whichever is lesser"

    "Single dose vials were used to provide multiple doses"

    ***Short version: they want us to only dose once per vial for fentanyl, propofol, phenylephrine, ephedrine, etc. And they want every medication to be wasted one hour after being pulled out. So if you pull out a medication 30 minutes prior to your case getting ready for next case. Then, take 30 minutes to drop patient off in PACU, see next patient, induce, position, prep, drape, etc. You should already be wasting and pulling out your second vial at the incision time (granted that times are a bit more than needed). Just seems beyond ridiculous and I can't believe that these are real.

    These are the policy changes implemented which are frustrating, especially when there are so many medication shortages! This change was actually way better than the previously suggestion to dispose after every dose. Can you imagine doing an induction? Versed/Lido/Fentanyl 50 mcg...waste. Propofol 150 mg.....waste. Sux.....waste. Oops, need more propofol. Pull out new vial and syringe. 50 mg.....waste. Oops, original propofol wore off. More propofol....waste. Hypertensive after induction....more fentanyl....more waste....I hope the sux hasn't wore off....etc, etc.

    I have tried explaining this to someone that obviously doesn't comprehend how this is impossible in an OR. If anyone else has dealt with this, I would love some feedbacak. Or your $0.02 even if you haven't dealt with it. Thanks!
     
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  3. Noyac

    Noyac ASA Member
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    This came about last year or so. It was my understanding that the OR got s pass on this but I’m not sure.

    This is something I consider to be a society issue, meaning our society (the ASA) should be all over this. Just like when the JC said we all had to wear boffant caps over the ears with no hair showing and that cloth caps were also not acceptable. The Surgical Society called BS. They then did their own review and issued a statement. The ASA has joined in on that statement. So you should write a letter to the ASA about this.
     
  4. dannyboy1

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    Whatever. Be nice when they are there. When they leave it’s back to business as usual
     
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  5. Psai

    Psai Account on Hold
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    Waste after every dose? Hahaha that is stupid

    It's amazing how much money hospitals pay this useless rent seeking organization to come by, do an "inspection" of something they have no concept of and follow their recommendations as though they were laid down in stone tablets from up above.

    I have better things to do than follow mandates from a bunch of idiots wearing suits, meandering around with clipboards trying to figure out their purpose in life.
     
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  6. NICMAN

    NICMAN ASA member, MD PhD
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    The JC said the same thing to us during our review. The hospital was forced to pay for drug and hat/mask gestapo to maintain 'standards' in the OR. It didn't matter if the case was a 7 hour pediatric heart, we had to pretend we were drawing up emergency drugs every hour. They would watch us on the OR cameras.

    Just another meaningless gesture of that will lead to harm. Fortunately I am going to a hospital that is accredited by Det Norske Veritas.
     
  7. narcusprince

    narcusprince Rough Rider
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    Looks like the drug companies have finally infiltrated the joint commission. How much money is wasted due to this policy. Just wasteful!
     
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  8. GravelRider

    GravelRider SDN Lifetime Donor
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    This sounds like a great, well thought out plan with all of our drug shortages.
     
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  9. dr doze

    dr doze To be able to forget means to sanity
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    We a got a pass for the one hour rule for the OR.
     
  10. Psai

    Psai Account on Hold
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    Why are we being surveilled by OR cameras in the first place?
     
  11. dipriMAN

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    I’m curious how they feel about infusions?? Especially from the syringe pump?

    Maybe you could chart it as an infusion of fentanyl for the case and adjust the dose to match the blouses you gave?
     
  12. IlDestriero

    IlDestriero Ether Man
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    We do not do that 1 hour nonsense either. However we only use one vial for one patient. It doesn’t matter if it is multi dose or not.


    --
    Il Destriero
     
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  13. BobLoblaw78

    BobLoblaw78 ASA Member

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    Unfortunately, their recommendations (not evidence based) are picked up by admin and pharmacy as permanent changes from up on high.
     
  14. Noyac

    Noyac ASA Member
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    Claim it is a pt privacy issue and they will go away.
     
  15. anbuitachi

    anbuitachi ASA Member
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    Agreed. It's a hipaa violation. they can't be going into ORs or watching ORs thru a camera!
     
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  16. Noyac

    Noyac ASA Member
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    Not if you have a truely physician lead organization. We have instilled this at our hospital and I am a part of a 6 physician board tasked with leading our hospital. We have as much say as any administrator, sans the CEO. But your CEO desperately wants a way to fight these bogus demands from bogus commissions. The CEO needs solid data which doctors are good at. You can fight this BS. But you need a hospital administration that needs you.
     
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  17. nimbus

    nimbus Member
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  18. nimbus

    nimbus Member
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    The inconsistency is mind boggling. Do they apply this for infusions in the ICU and every place else in the hospital? Insulin, vasoactive drips, TPN, propofol, maintenance IV fluids? Do 6 hour chemo infusions need to be divided into 6 separate 1 hour bags? These are all medications. Switch out to a new bag every hour?

    Clueless inmates are truly running the asylum.
     
    #17 nimbus, May 9, 2018
    Last edited: May 9, 2018
  19. BobLoblaw78

    BobLoblaw78 ASA Member

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    I should clarify, that they don't want us using more than one dose even on the same patient regardless of the vial type. They don't even want multiple doses from the same syringe. Hence, they want us to waste the whole syringe after each dose.
     
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  20. BobLoblaw78

    BobLoblaw78 ASA Member

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    Agree full-heartedly and working to get there!
     
  21. anbuitachi

    anbuitachi ASA Member
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    I'd quit the job if they don't change it and try to enforce it.. ridiculous. Clearly the department doesn't have your back
     
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  22. BobLoblaw78

    BobLoblaw78 ASA Member

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    Well, I am not enforcing it....so I hope no one quits! Lololol

    I am trying to change it, that is why I am looking for solutions and workarounds! The administration is actually quite supportive, just pharmacy director issue. The JC recommendations plus poor interpretation leads to a lot of headaches.
     
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  23. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay
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    Then the solution is simple: Fire the pharmacy director.
     
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